Neurally adjusted ventilatory assist mode used in congenital diaphragmatic hernia.

A term baby with congenital diaphragmatic hernia (CDH) underwent surgical repair on the second day of life. Postoperatively; the oxygenation index increased to 85 despite high pressure ventilation with HFOV (high frequency oscillator ventilation) and inhaled nitric oxide therapy. Oxygenation index above 70 carries a mortality rate of 94% and merits starting extracorporeal membrane oxygenation (not available in the UAE). A trial of neurally adjusted ventilatory assist (NAVA) on the 10th postoperative day was followed by a reduction of oxygenation index to 15 and marked improvement of the clinical parameters. The EAdi (electrical activity of diaphragm) signal was relatively weak (± 5 μvolt) requiring augmentation with a high NAVA level (3 - 3.5). The patient was successfully extubated after 3 weeks.